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In Reply: Dr Sataloff’s concern about the choice of the control group in our study seems to assume that all patients taking proton pump inhibitors had gastroesophageal reflux disease. However, only 30% of our study population had endoscopically confirmed gastroesophageal reflux disease. If Dr Sataloff is correct that reflux is associated with pneumonia, we would have expected reflux esophagitis to have been more frequently present in patients with pneumonia than in the control group. This was not the case, as was shown in Table 2 of our article. We also note that an American Gastroenterological Association consensus panel concluded that causation has not been established for pulmonary extraesophageal manifestations of gastroesophageal reflux disease.¹

However, we do agree that more research on the cause of our findings is necessary. Data on the contribution of gastric acid–suppressive drugs to the acquisition of community-acquired pneumonia and its pathogenesis are limited. We know . . . [Full Text of this Article]

Robert J. F. Laheij, PhD
R.Laheij@mdl.umcn.nl
Department of Gastroenterology
University Medical Center St Radboud
Nijmegen, the Netherlands

Miriam C. J. M. Sturkenboom, PhD; Jeanne Dieleman, PhD; Bruno H. C. Stricker, MD, PhD
Department of Medical Informatics
Erasmus MC University, Medical Center
Rotterdam, the Netherlands

Jan B. M. J. Jansen, MD, PhD
Department of Gastroenterology
University Medical Center St Radboud
Nijmegen, the Netherlands

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